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Samenvatting anatomie deel 1

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  • Grays Anatomy For Students

Deze samenvatting is gebaseerd op de hoorcolleges van de eerste bachelor geneeskunde van het vak Anatomie. Het bestaat uit 2 delen, omdat het oorspronkelijk een te groot bestand was. Dit is deel 1 en behandelt: lymfesysteem, zenuwstelsel, hals, thorax en abdomen. Het is een goede bundel van alles w...

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  • No
  • De hoofdstukken die in de colleges aan bod kwamen. zo goed als alles
  • October 29, 2020
  • 67
  • 2019/2020
  • Summary

Subjects

  • geneeskunde
  • anatomie
  • thorax
  • abdomen
  • zenuwstelsel
  • lymfesysteem
  • hals
  • bachelor
  • ua
  • universiteit antwerpen

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2019-2020 Samenvatting
anatomie
Deel 1




Kjell Van Rompa
1 BA GENEESKUNDE

,1

,Inhoudsopgave
ROMP (HALS, THORAX, ABDOMEN, PELVIS) ..................................................................................................... 6
LYMFESYSTEEM ................................................................................................................................................ 6
OPBOUW ............................................................................................................................................................... 6
Lymfe .............................................................................................................................................................. 6
Lymfevaten ..................................................................................................................................................... 6
Lymfatisch weefsel ......................................................................................................................................... 6
Lymfeknopen of -klieren ................................................................................................................................. 6
Lymfoïde organen ........................................................................................................................................... 6
FUNCTIES ............................................................................................................................................................... 7
Vocht heropname ........................................................................................................................................... 7
Immuniteitsreacties ........................................................................................................................................ 7
Vetabsorbties ................................................................................................................................................. 7
ZENUWSTELSEL ................................................................................................................................................ 7
INDELING ............................................................................................................................................................... 7
HET ENTERISCH ZENUWSTELSEL (EZS) .......................................................................................................................... 8
ORTHOSYMPATISCH SYSTEEM ..................................................................................................................................... 9
Opbouw .......................................................................................................................................................... 9
Sympatische innervatie van thoracale en cervicale organen ......................................................................... 9
Sympatische innervatie in het abdomen, pelvis en bijnieren........................................................................ 10
Effecten OS op verschillende targetorganen ................................................................................................ 10
PARASYMPATISCH SYSTEEM ..................................................................................................................................... 11
Opbouw ........................................................................................................................................................ 11
Preganglionaire PS craniale zenuwen .......................................................................................................... 11
Preganglionaire PS sacrale zenuwen ............................................................................................................ 11
Effecten PS op effectororganen .................................................................................................................... 11
HALS ............................................................................................................................................................... 12
HALS ALS GEHEEL ................................................................................................................................................... 12
REGIO’S VAN DE HALS ............................................................................................................................................. 13
Algemeen...................................................................................................................................................... 13
Posterieure halsdriehoek .............................................................................................................................. 13
Algemeen ................................................................................................................................................................... 13
Spieren ....................................................................................................................................................................... 14
Bloedvoorziening en innervatie ................................................................................................................................. 14
Anterieure halsdriehoek ............................................................................................................................... 15
Algemeen ................................................................................................................................................................... 15
Spieren ....................................................................................................................................................................... 15
Bloedvaten ................................................................................................................................................................. 16
Zenuwen .................................................................................................................................................................... 17
Lymfeknopen ............................................................................................................................................................. 18
Organen: schildklier en bijschildklieren ..................................................................................................................... 18
Halsbasis ....................................................................................................................................................... 19
Algemeen ................................................................................................................................................................... 19
Bloedvaten ................................................................................................................................................................. 19
Zenuwen .................................................................................................................................................................... 20
Lymfewegen............................................................................................................................................................... 20
GESPECIALISEERDE STRUCTUREN IN HALS .................................................................................................................... 20
Pharynx of keel ............................................................................................................................................. 20
Algemeen ................................................................................................................................................................... 20
Spieren vd pharynx ............................................................................................................................................... 20
Doorbloeding ........................................................................................................................................................ 21
Innervatie .............................................................................................................................................................. 21
Nasopharynx .............................................................................................................................................................. 21
Oropharynx ................................................................................................................................................................ 21
Hypopharynx (=laryngoharynx) ................................................................................................................................. 21



2

, Larynx of strottenhoofd ................................................................................................................................ 22
Algemeen ................................................................................................................................................................... 22
Kraakbeenstructuren larynx ...................................................................................................................................... 23
Cartilago cricoidea ................................................................................................................................................ 23
Cartilago thyroidea ............................................................................................................................................... 23
Arytenoiden .......................................................................................................................................................... 23
Epiglottis ............................................................................................................................................................... 23
Intrinsieke ligamenten van de larynx ......................................................................................................................... 23
Lig. Cricothyroideum ............................................................................................................................................. 23
Membrana quadrangularis ................................................................................................................................... 24
Regio’s larynx ........................................................................................................................................................ 24
Bloedvoorziening ....................................................................................................................................................... 24
Bezenuwing................................................................................................................................................................ 25
Functies ...................................................................................................................................................................... 26

THORAX ......................................................................................................................................................... 27
THORAX ALS GEHEEL ............................................................................................................................................... 27
Algemeen...................................................................................................................................................... 27
Diafragma .................................................................................................................................................... 27
REGIO PECTORALIS ................................................................................................................................................. 28
Algemeen...................................................................................................................................................... 28
Spieren regio pectoralis ................................................................................................................................ 28
Borstklier of glandula mammaria ................................................................................................................. 29
THORAXWAND ...................................................................................................................................................... 29
Algemeen...................................................................................................................................................... 29
Intercostaalarteriën ...................................................................................................................................... 29
Intercostaalvenen ......................................................................................................................................... 29
Intercostaalzenuwen .................................................................................................................................... 29
Lymfedrainage thoraxwand ......................................................................................................................... 29
PLEURAHOLTES...................................................................................................................................................... 30
Algemeen...................................................................................................................................................... 30
Longen .......................................................................................................................................................... 30
Projectie van longen en pleurae op de thoraxwand ..................................................................................... 32
Trachea en bronchaalboom .......................................................................................................................... 33
Arteriae & venae pulmonales ....................................................................................................................... 33
Long en viscerale pleura bezenuwing ........................................................................................................... 33
Lymfedrainage long ...................................................................................................................................... 34
MEDIASTINUM ...................................................................................................................................................... 34
Algemeen...................................................................................................................................................... 34
Mediastinum superius .................................................................................................................................. 34
Algemeen ................................................................................................................................................................... 34
Thymus/zwezerik ....................................................................................................................................................... 35
Trachea + oesophagus ............................................................................................................................................... 35
V. brachiocephalica sinistra/dextra ........................................................................................................................... 35
V. cava superior ......................................................................................................................................................... 35
N. vagus ..................................................................................................................................................................... 35
N. phrenicus ............................................................................................................................................................... 35
Aortaboog + 3 zijtakken ............................................................................................................................................. 36
Ductus thoracicus ...................................................................................................................................................... 36
Mediastinum anterius .................................................................................................................................. 36
Mediastinum medius .................................................................................................................................... 37
Algemeen ................................................................................................................................................................... 37
Pericard ...................................................................................................................................................................... 37
Hart (cor).................................................................................................................................................................... 37
Algemeen .............................................................................................................................................................. 37
Rechteratrium ....................................................................................................................................................... 38
Rechterventrikel.................................................................................................................................................... 39
Linkeratrium .......................................................................................................................................................... 39
Linkerventrikel ...................................................................................................................................................... 39
Auscultatie hart ..................................................................................................................................................... 40



3

, Vascularisatie : coronair systeem .......................................................................................................................... 40
Prikkelvormings- en geleidingssysteem ................................................................................................................ 41
Hartinnervatie ....................................................................................................................................................... 42
Mediastinum posterius ................................................................................................................................. 42
Algemeen ................................................................................................................................................................... 42
Oesophagus ............................................................................................................................................................... 42
Algemeen .............................................................................................................................................................. 42
Bloedvoorziening .................................................................................................................................................. 43
Lymfedrainage ...................................................................................................................................................... 43
Bezenuwing ........................................................................................................................................................... 43
Aorta thoracica .......................................................................................................................................................... 43
Azygossysteem ........................................................................................................................................................... 43
Ductus thoracicus ...................................................................................................................................................... 44
Truncus sympathicus ................................................................................................................................................. 44

ABDOMEN ...................................................................................................................................................... 45
ALGEMEEN OVERZICHT............................................................................................................................................ 45
ABDOMINALE WAND .............................................................................................................................................. 47
Algemeen...................................................................................................................................................... 47
Buikspieren ................................................................................................................................................... 48
Rectusschede ................................................................................................................................................ 49
Bezenuwing .................................................................................................................................................. 49
Arteriële bevloeiing van buikwand ............................................................................................................... 49
Lymfedrainage .............................................................................................................................................. 50
Toegangswegen - Laparotomie .................................................................................................................... 50
LIES EN LIESKANAAL ................................................................................................................................................ 50
Algemeen...................................................................................................................................................... 50
Lieskanaal ..................................................................................................................................................... 51
Ductus spermaticus ...................................................................................................................................... 52
PERITONEUM EN PERITONEAAL HOLTE (CAVUM PERITONEI) ........................................................................................... 53
VISCERA ............................................................................................................................................................... 55
Oesophagus .................................................................................................................................................. 55
Gaster (maag) .............................................................................................................................................. 55
Algemeen ................................................................................................................................................................... 55
Bloedvoorziening ....................................................................................................................................................... 55
Lymfedrainage ........................................................................................................................................................... 55
Bezenuwing................................................................................................................................................................ 56
Duodenum (twaalfvingerige darm) .............................................................................................................. 56
Jejunum-ileum .............................................................................................................................................. 57
Colon............................................................................................................................................................. 57
Algemeen ................................................................................................................................................................... 57
Bloedvoorziening ....................................................................................................................................................... 58
Veneuze drainage van GI-kanaal................................................................................................................................ 58
Lymfedrainage maag/darmkanaal ............................................................................................................................. 58
Hepar (lever) ................................................................................................................................................. 59
Galblaas ........................................................................................................................................................ 60
Pancreas ....................................................................................................................................................... 60
Milt ............................................................................................................................................................... 61
POSTERIEURE ABDOMINALE REGIO ............................................................................................................................ 61
Algemeen...................................................................................................................................................... 61
Posterieure abdominale wand...................................................................................................................... 62
Nieren ........................................................................................................................................................... 62
Ureters .......................................................................................................................................................... 63
Bijnieren........................................................................................................................................................ 64
Zenuwbanen ................................................................................................................................................. 64
BRONNENLIJST ............................................................................................................................................... 66




4

,5

,Romp (hals, thorax, abdomen, pelvis)
Lymfesysteem
Opbouw
Lymfe
Vocht verzameld vanuit interstitiële ruimte weefsels → bloedcirculatie
Bevat lymfocyten (type WBC) en macrofagen (cel die restjes kan omzetten in interstitieel materiaal).

Lymfevaten
Zorgen voor circulatie lymfe:
▪ Contractie lymfevaten
▪ Contractie omliggende skeletspieren
▪ Drukveranderingen thorax
Zitten niet in CZS, beenmerg en avasculaire
weefsels.
Ze hebben:
▪ Kleppen voor unidirectionele flow
▪ Geen basaal membraan
▪ Geen pomp zoals het hart
Permeabel
▪ Overlappend epithale begrenzing
Alle efferente lymfevaten → lymfetrunci → 2
lymfeafvoergangen → veneuze circulatie
Lymfeafvoergangen:
▪ Ductus lymfaticus dexter: draineert rechterste bovenste lidmaat, rechterzijde thorax en
hoofd in v. subclavia dexter
▪ Duxtus thoracicus: draineert rest lichaam in v. subclavia sinister

Lymfatisch weefsel
Omvat aggregaten van lymfocyten en macrofagen in MALT (mucosa-associated lympathic tissue):
gastrointestinale tractus, tonsillen, ademhalings-, urinair en reproductief stelsel.

Lymfeknopen of -klieren
Boonvormige, omkapselende structuren die lymfedrainage onderbreken.
Meer afferente banen komen toe (convexe kant) dan dat er efferente vertrekken (hilus).
Functie = filter voor pathogene kiemen en (maligne) cellen.
Palpabele knopen: hals, oksel, lies
Niet-palpabele knopen: trachea, bronchi, thorax, para-aortaal in abdomen
Virchow-klier:
▪ Belangrijke palpeerbare klier
▪ Supraclaviculair bij uitmonding ductus thoracicus
▪ Bij uitzaaiing (van vb. borst- of slokdarmkanker) via ductus thoracicus → opzwelling

Lymfoïde organen
Thymus en milt (later besproken)




6

,Functies
Vocht heropname
(Interstitieel) vocht filtert continu uit capillairen in weefsels → bloedcapillairen 85% heropname +
lymfecapillairen 15% heropname
Deze 15% = 2-4L water + plasmaproteïnen => zonder lymfebanen → ‘verdrinken’ in vocht
Partiële interferentie lymfecirculatie → vochtophoping = lymfoedeem

Immuniteitsreacties
Ook cellen + pathogenen opgenomen → gefilterd in knopen → hier lokken immuuncellen
(inflammatoire/maligne) reactie uit → knopen vergroten pathologisch → easy op te sporen

Vetabsorbties
In dunne darm: vetten uit voedsel door darmslijmvlies verwerkt tot chylomicronen (proteïnegecoate
lipidedruppels).
Chylomicronen te groot voor vasculaire capillairen → vanuit epitheelcellen in IC (interstitieel
compartiment) → meegenomen door lymfen
Lymfe vanuit dunne darm = chyle (=wit)


Zenuwstelsel
Indeling




Somatisch ZS:
▪ Innervatie structuren zoals huid, meeste skeletspieren aflomstig somieten embryo
(embryonaal oersegment)
▪ Opgebouwd uit:
o Afferente sensorische zenuwen (van periferie naar CZS)
o Efferente motorische zenuwen (van CZS naar skeletspier)




7

,Visceraal ZS of autonoom ZS (AZS):
▪ Bezenuwing organen, gladde spieren en klieren (in periferie)
o Sensorisch component: monitoring veranderingen
binnen organen (pH, druk bij voedsel in maag)
o Motorisch component: bezenuwing gladde
spierweefsel, hartspier en klieren
▪ Gestuurd door hypothalamus
▪ In- en uitgangen viscerale vezels:
o Craniale zenuwen (III, VII, IX en X) (parasympatisch)
o Ruggenmergnieveaus: T1-L2 (sympatisch) en S2-S4
(parasympatisch)

Sensorische vezels:
▪ Functionele overlap: kan zowel somatisch als visceraal zijn
▪ Periferie naar CZS

Motorische vezels:
▪ Somatisch ZS:
o 1 Neuron van CZS naar effectororgaan
o Cellichaam neuron in ventrale hoorn ruggenmerg (of motorische kernen craniale
zenuwen)
o Vanuit cellichaam → axon via voorste wortel uit CZS in 1 keer naar effectororgaan
▪ Visceraal ZS:
o 2 neuronen in serie: pre- en postganglionair neuron
o Preganglionaire neuron: lateraal in ruggenmerg → tussenstation = autonoom
ganglion (buiten CZS gerangschikt) → hierin synaps met postganglionaire neuron →
effectororgaan

Het enterisch zenuwstelsel (EZS)
Complex netwerk neuronale cellichamen en axonen in wand spijsverteringskanaal hebben een
belangijke rol bij darmmotiliteit, secretie van darmsappen en absorptie en zijn georganiseerd in 2
plexussen:
▪ Myenterische plexus (pl. van Auerbach)
▪ Submucosale plexus (pl. van Meissner)




8

, Orthosympatisch systeem
Opbouw
Deel visceraal ZS en verlaat ruggenmerg samen met somatische spinale zenuwen van T1-L2.
Paravertebrale ganglia: keten sympatische ganglia aan weerszijde vd wervelkolom; convergeren in
ganglion impar thv os coccygis (ganglion van Walther).
Truncus sympaticus: paravertebrale ganglia samen met opklimmende/dalende vezels
Viscerale motorische vezels via voorste wortel uit ruggenmerg → takken af naar paravertebraal
ganglion via witte ramus communicans (is gemyeliniseerd).
Vanuit witte ramus kan OS motorische vezel:
1. Synaps vormen met postganglionaire vezel:
a. Via grijze ramus communicans → zelfde spinale zenuw op zelfde hoogte →
sympatische innervatie huid (zweetklieren en mm. Erector pili), gladde spiercellen
(bloedvaten dermatoom)
b. Via eigen viscerale zenuw op zelfde hoogte → innervatie thoracale viscera
2. Doorheen paravertebrale ganglion lopen zonder synaps:
a. Opstijgen/dalen → hoger/lager ganglion → synaps postganglionaire vezel → via
grijze ramus communicans → spinale zenuw → sympatische innervatie dermatomen
(boven/onder T1-L2)
b. Opstijgen/dalen → hoger/lager ganglion → synaps postganglionaire vezel → eigen
viscerale zenuw → innervatie cervicale en thoracale organen
c. Convergeren met andere preganglionaire OS vezels als nn. Splanchnici (major,
minor, imus en lumbales) → synaps in prevertebrale ganglia → innervatie
abdominale en pelvische organen
d. Bijnier (schors of merg) → secretie bepaalde hormonen (adrenaline + noradrenaline)




Sympatische innervatie van thoracale en cervicale organen
Vanuit T1-T5: viscerale preganglionaire motorische vezels (zoals 1.b en 2.b) tot postganglionaire
vezels → lopen samen → vormen viscerale autonome zenuwen vb. cardiale OS vezels.
Meestal samen met takken PS in plexussen op orgaan vb. cardiale of pulmonaire viscerale plexus.




9

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